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Jr Reporting Analyst, Utilization Management and Claims

Summary

The Jr Reporting Analyst, Utilization Management and Claims is responsible for ensuring accurate, timely, and efficient reporting and input of data related to all Claims and UM functions. Reporting to the Director, Strategy and Operations, the primary functions of this position are to manage scheduled and ad hoc reporting needs, troubleshoot data integrity issues, and analyze data. The position will play a significant role in supporting the department’s strategic goals.


Duties and Responsibilities

  • Prepares universe reports for health plan audits, Monthly Timeliness Reports, Medicare reporting and other Health Plan or regulatory requests
  • Ensures and manages the execution of regular, new, and ad hoc reporting for Claims and UM Operation
  • Assists with preparation of Claims and UM Committee meetings
  • Attends health plan audits and data validations and reports finding back to internal team
  • Identifies existing inefficiencies and problems within data sets/reports and takes action to remediate
  • Conducts quality assurance and scrubs data to ensure validity and accuracy of analytical results
  • Works closely with IT to communicate reporting needs and specifications in order to ensure efficient report development and execution
  • Uses appropriate technical, operational and/or financial knowledge to assess the completeness and reliability of data
  • Interacts with internal stakeholders (Claims, Compliance, Utilization Management, Provider Services, Finance, IT) to define analytical needs and create accurate analyses that support decision-making
  • Ability to communicate analytical results in abstracts, graphs, or summaries that clearly and succinctly convey information that is easily understood by non-technical persons
  • Provides input on and supports the standardization of business rules and methods for analysis and reporting
  • Supports staff trainings to improve accuracy of data and enhance quality of reports delivered by other departments

Minimum Job Requirements:

  • BA in Finance, Engineering, Math, or other analytical field or 2 years of experience in a reporting/analytic function in a healthcare environment
  • Must have sufficient familiarity with the technical knowledge necessary to adequately perform the duties described above
  • Intermediate Microsoft Excel skills
  • Ability to identify, analyze, and interpret trends or patterns in complex data sets
  • Knowledge of Tableau, SQL preferred but not required

Knowledge, Skills, and Abilities Required:

  • Ability to maintain multiple priorities and deadlines, with strong follow through
  • Highly motivated with strong attention to detail
  • Ability to work independently and take direction
  • Communicates effectively and works well in a team

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Job title: Jr Reporting Analyst, Utilization Management and Claims

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